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Lecture

Personality Disorders Pt. 2.

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Department
Psychology
Course
PSYCH 257
Professor
Allison Kelly
Semester
Winter

Description
LECTURE17 P ERSONALITY D ISORDERS –P ART 2 OF 2 C HAPTER 12 OF TEXTBOOK RECAP: Last Class  The nature of personality disorders o On axis two – more stable and chronic. Disorders that are considered to last a lifetime in most cases  Cluster A PDs o Paranoid, schizoid, schizotypal  Cluster C PDs o Avoidant, dependent, obsessive-compulsive Today’s Outline  Cluster B personality disorders: Emotional, dramatic disorder o Borderline  Notorious for the harm that people suffering can cause to themselves (and others) o Narcissistic o Histrionic o Antisocial  Pose a risk to society – break the law o Summary game – name that PD Borderline PD Overview Characteristics  Unstable emotions o In the course of a day, and even an hour  Patterns of unstable moods, relationships, and impulsive behaviours o Have intense relationships and then all of a sudden they hate that person and wish them dead o Act out in ways that are harmful to themselves (emotionally harmful to others) 1  Profound fear of abandonment o Worry that they will be alone and that they are not loved  Emptiness and poor self-image o Don’t have a strong sense of who they are or what they want o Easily influenced by partner  Difficulties with emotion regulation and distress tolerance  self-mutilation o Difficulty to experience an emotion and cope with it  Not having a strong reaction ** VIDEO**: Girl Interrupted Assessment Interview (YOUTUBE) o Feel like they have no hope DSM Symptoms  Frantic efforts to avoid abandonment  Pattern of unstable relationship characterized by extremes  Unstable self-image  Impulsivity that are self-damaging  Recurrent suicidal behaviour, gestures, or threats, or self-mutilation  Mood instability  Chronic feelings of emptiness  Inappropriate anger  Transient, stress-related paranoid ideation or severe dissociative symptoms o Can include drinking a lot  Jeopardizing their safety o Eating Disorders o Hear voices  Know that they are coming from themselves  Understanding Self Mutilation in BPD video o Way to punish yourself for the impulsivity o Blood is cleansing? o Release of strong feelings o Blood and physical pain is way of validating what went wrong o Cutting themselves, burning themselves, scratching and punching 2 Prevalence & Comorbidity Prevalence  General population o 1-2%: Diagnosed more in females  Psychiatric settings o In patient: 20% o Out-Patient 10%  Females > males Comorbidity  Other PDs o Antisocial, schizotypal, histrionic o Substance related disorders, PTSD, mood disorders o History of abuse Etiology Biological factors  Tends to run in families o Environmental or biological?  Genetics related to impulsivity or lower serotonin  Consensus: Biological doesn’t explain it all Psychological factors  Born with Stronger attachment needs  Impulsivity  Emotional reactivity Social factors  Invalidating environment o Feeling sad as a child optimal validating thing is parent supporting and be warm  Invalidating: “you’re not sad”, not giving them attention  Abuse, neglect, maltreatment o High rates  61% have history of sexual abuse vs. 32% with other personality disorders  90% with BPD have some form of abuse in history 3  Part of the answer? Diathesis-stress model of BPD Treatment Crisis intervention  Dealing with them when they come into ER from suicide attempt Psychotherapy  Dialectical Behaviour Therapy (DBT) o Developed by someone with BPD o People become much less suicidal, fewer visits to ER o Helps a lot with major features  Outcome studies  Treatment of choice Medication  SSRIs o Used to help with low mood  Mood stabilizers  No research to suggest that these on their own will help o Used in conjunction with others 4 Dialectical Behavioral Therapy (DBT) Structure of DBT  Long term: about a year  Weekly skills training session o Focus on skills themselves, not emotions o Teach them to behave and respond in more adaptive, helpful ways  Weekly therapy  24/7 therapist on call o If they have already self harmed by the time they call the therapist, then they can’t get help and can’t talk to therapist for 48 hours  Teaches them to call before harm  Reward for calling for help when they have urge to self harm – commit to not acting out when they feel like it but to cope.  Support for therapists o Work in teams to support each other Therapist qualities and focus  Validation, genuineness  “Radical acceptance” AND change o Acting in a way that says we accept you and that you want to self harm, but we are encouraging change  How can I help you change  Dialectical Therapy Skills training  Mindfulness o Not becoming overwhelmed o Making sense of things  Emotional regulation o Calling therapist  Distress tolerance o That don’t involve self harm o Going for a walk, taking a bath, playing with dog  Interpersonal effectiveness o Ways to resolve conflict without acting out and hating the person 5  Not ending the relationship Summary: BPD  Disorder characterized by emotional deregulation  Environmental ad biological factors  Dialectical therapy helps Histrionic PD Overview Characteristics  Overly dramatic and attention-seeking  Strong need to be center of attention o Dress provocatively, o Talk really eccentrically o Meet them once and they act like your best friends ** Video ** Basic Instinct o Scene when she opens her legs and reveals she is not wearing any underwear is very characteristic of histrionic personality disorder  Use physical appearance to draw attention  Theatrical  Extravagant emotion with rapid shifts, suggesting more shallow than sincere  Overly dramatic 6 Symptoms  Need to be center of attention, uncomfortable when not  Interactions with others – inappropriately sexually seductive or provocative behaviour  Rapidly shifting and shallow expression of emotion  Use of physical appearance to draw attention to self  Style of speech that is highly impressionistic and lacking in detail  Dramatic, theatrical, exaggerated expression of emotion  Suggestible  Thinks relationships are more intimate than
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